"Our Patients" as Rationale

Recently, the CEO of The Mayo Clinic, based in Rochester, MN, was interviewed regarding healthcare costs.  Read the interview at http://au.finance.yahoo.com/news/mayo-clinic-ceo-heres-why-155300485.html.

I worked at the Mayo Clinic in Rochester for 8 years so I still pay attention when Mayo speaks.  As I read the interview, two thoughts kept changing places in my mind.

"That's true." and "So what?" 

You'll note that "the needs of our patients" combined with "We've been doing this for a long time." are offered as the sole justification for any decisions made with respect to costs.  Without in any way detracting from the accomplishments and traditions of Mayo and not seeking to damage the esteem in which the Mayo name is held throughout the world, we need better justification and we need data.

It has been noted frequently that "I'm a doctor.  I know what's best for you." is a common attitude in the exam room.  Younger physicians are being educated away from that attitude but it is true that any physician knows a lot more about manipulating the human organism than the typical patient.  You can also see that the veneer of reeducation is quite thin if you venture to disagree with your physician about your diagnosis or treatment.

Well, that's the way it is and I'm willing to tolerate it when I'm sick.  That's medicine though and in medicine arrogance is treated as a fact of life and even valued.  In business and in fiscal policy, though, arrogance is non-productive and even counter-productive.

"The needs of my/our patients" is a greatest common denominator approach that guarantees the highest possible costs.  In a closed system (a specific clinic for example), an individual physician may be required to justify a particular therapy to a committee (for example, a transplant committee) and, in fact, the therapy may be denied even though it clearly is in the best interests of a particular patient.  When it comes to expenditures, however, there may be no scientific basis for decisions or, if there is, it is science mis-applied.  One of the most often heard arguments for an expenditure is that "everyone else is getting this."

My mother never accepted that as a valid reason but it is very often good enough for the board to approve expenditures of tens of millions of dollars.  Even that wouldn't be so bad, but the followup on those expenditures is woefully inadequate.  One thing I have observed in 13 years in healthcare is that no one ever looks back from a decision to spend money.  "I don't want to look at this too closely or my decision may be next under the microscope."

Medicine and healthcare are two different things entirely.  The system of healthcare in the US is terminally flawed and to the extent that it influences Medicine, the practice of medicine is as well.  Ask yourself how many of your healthcare dollars go into perpetuating the system rather than into preventing illness.  I don't have the numbers, but a comparison of dollars spent on basic medical research with dollars spent on lobbying and publicity would probably be too frightening for publication.